ArticleStatistics in medicine2017
The median hazard ratio: a useful measure of variance and general contextual effects in multilevel survival analysis.
Article in Statistics in medicine, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 58 papers, 2 of them syntheses that pooled it.
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Who cites it
58 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- IPDMA - RADICAL - NSCLC: individual participant data meta-analysis and systematic review of radical local therapy for oligometastatic NSCLC.BMJ open respiratory research · 2025Pooled it
- Individual participant data meta-analysis of intervention studies with time-to-event outcomes: A review of the methodology and an applied example.Research synthesis methods · 2020Pooled it
- Geographical variation and area-level socioeconomic disadvantage in recognized depression: A nationwide register-based Danish cohort study.Social psychiatry and psychiatric epidemiology · 2026Article
- Psychosocial Risk and Resilience as Moderators of the Association Between Neighborhood Disadvantage and Incident Cardiovascular Disease Across Ethnoracial Groups: Multi-Ethnic Study of Atherosclerosis, United States, 2000-2019.American journal of public health · 2026Article
- Extending the Median Odds Ratio (MOR), the Interval Odds Ratio (IOR), and the Proportion of Opposed Odds Ratios (POOR) for Use With 3-Level Multilevel Logistic Regression Models.Statistics in medicine · 2026Article
- Standardized survival probabilities and contrasts between hierarchical units in multilevel survival models.BMC medical research methodology · 2026Article
- Adherence to monitoring iron indices at the initiation of erythropoiesis-stimulating agents or hypoxia-inducible factor prolyl hydroxylase inhibitors.Clinical and experimental nephrology · 2026Article
- Impact of small area-level deprivation on survival outcomes in patients with Cholangiocarcinoma: a population-based multilevel survival analysis.Frontiers in public health · 2026Article
- Factors Associated with Progression to Type 2 Diabetes among Women with Gestational Diabetes.Journal of urban health : bulletin of the New York Academy of Medicine · 2025Article
- Factors Associated with Same-Day Discharge After Catheter Ablation Procedures for Supraventricular Tachycardia in Ontario, Canada.CJC open · 2025Article
- Immunization Coverage and Its Determinants Among Children Aged 12-23 Months in East Africa: A Bayesian Hierarchical Modeling Approach Based on DHS 2019-2022.BioMed research international · 2025Article
- Quantifying the magnitude of the general contextual effect in a multilevel study of SARS-CoV-2 infection in Ontario, Canada: application of the median rate ratio in population health research.Population health metrics · 2024Observational
- Frequency of antimicrobial-resistant bloodstream infections in 111 hospitals in Thailand, 2022.The Journal of infection · 2024Article
- Predictors of COVID-19 infection and hospitalization in group homes for individuals with intellectual and/or developmental disabilities.Disability and health journal · 2024Article
- Ferritin Cutoffs and Diagnosis of Iron Deficiency in Primary Care.JAMA network open · 2024Article
- Article
- Regional disparities in the use of intensive chemotherapy for AML in the Netherlands: does it influence survival?BMJ oncology · 2024Article
- Variation in the Care of Children with Inflammatory Bowel Disease Within and Across Canadian Provinces: A Multi-Province Population-Based Cohort Study.Clinical epidemiology · 2024Article
- COVID-19-Related Outcomes Among Group Home Residents with Serious Mental Illness in Massachusetts in the First Year of the Pandemic.Administration and policy in mental health · 2024Article
- Distinct moderating pathways for psychosocial risk and resilience in the association of neighborhood disadvantage with incident heart failure among Black persons.SSM - population health · 2023Article
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Authors and funding
3 authors.
Funding
Abstract
Multilevel data occurs frequently in many research areas like health services research and epidemiology. A suitable way to analyze such data is through the use of multilevel regression models (MLRM). MLRM incorporate cluster-specific random effects which allow one to partition the total individual variance into between-cluster variation and between-individual variation. Statistically, MLRM account for the dependency of the data within clusters and provide correct estimates of uncertainty around regression coefficients. Substantively, the magnitude of the effect of clustering provides a measure of the General Contextual Effect (GCE). When outcomes are binary, the GCE can also be quantified by measures of heterogeneity like the Median Odds Ratio (MOR) calculated from a multilevel logistic regression model. Time-to-event outcomes within a multilevel structure occur commonly in epidemiological and medical research. However, the Median Hazard Ratio (MHR) that corresponds to the MOR in multilevel (i.e., 'frailty') Cox proportional hazards regression is rarely used. Analogously to the MOR, the MHR is the median relative change in the hazard of the occurrence of the outcome when comparing identical subjects from two randomly selected different clusters that are ordered by risk. We illustrate the application and interpretation of the MHR in a case study analyzing the hazard of mortality in patients hospitalized for acute myocardial infarction at hospitals in Ontario, Canada. We provide R code for computing the MHR. The MHR is a useful and intuitive measure for expressing cluster heterogeneity in the outcome and, thereby, estimating general contextual effects in multilevel survival analysis. © 2016 The Authors. Statistics in Medicine published by John Wiley & Sons Ltd.
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